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General NPI Number Information
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NPI Number | 1366549016
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Entity Type | Organization
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Legal Business Name | LAGUNA PATHOLOGY MEDICAL GROUP
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Dates
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Enumeration Date | 09/17/2006
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Last Update Date | 12/20/2007
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Provider Practice Location Address
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Address Line | 31872 COAST HWY
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-6773
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Country | US
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Telephone | 949-499-7181
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7630
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92607-7630
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHRISTOPHER VANLEY
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Credential | M.D.
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Telephone | 949-499-7181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State | CA
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